In Reply.—It is generally conceded that the incidence of complications increases with increasing duration of intubation, whether translaryngeal or transtracheal, in a linear correlation.1 In addition, a closer look at the study by Allen and Steven2 shows that 87% of their patients were intubated for two weeks or less and only 4% for greater than four weeks. Also, 22% of the patients died, indicating that possibly more lesions might have been discovered later if these patients had survived. So, although Dr Beer's report is supportive and reassuring, to our viewpoint, a note of caution must be injected.Certainly, we also have had patients with various forms of respiratory failure with successful use of translaryngeal intubation for periods substantially longer than two weeks in our institutions. It must be stressed, however, that these cases are sporadic and anecdotal. As indicated by our article, available evidence now implies that